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Individual

DR. GARY D TENNANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
386 FOREST BLVD, PARK FOREST, IL 60466-2005
(708) 481-1715
(708) 481-8915
Mailing address
386 FOREST BLVD, PARK FOREST, IL 60466-2005
(708) 481-1715
(708) 481-8915

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-005464
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1622660
BCBSIL
IL
01
350056091
RR MEDICARE
IL
Enumeration date
03/17/2006
Last updated
01/15/2008
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